BlueCross BlueShield of Tennessee Medical Policy Manual

Home Nutritional Support (Total Parenteral/Enteral Nutrition)

DESCRIPTION

Total parenteral nutrition (TPN), also known as parenteral hyperalimentation, is used for individuals with medical conditions that impair gastrointestinal absorption to a degree incompatible with life. It is also used for variable periods of time to bolster the nutritional status of severely malnourished individuals with medical or surgical conditions. TPN involves percutaneous transvenous implantation of a central venous catheter into the vena cava or right atrium. A nutritionally adequate hypertonic solution consisting of glucose, amino acids, electrolytes, vitamins, and minerals and sometimes fats, is administered daily. An infusion pump is generally used to assure a steady flow of the solution either on a continuous (24-hour) or intermittent schedule. The catheter is kept patent between infusions.

Enteral nutrition (EN) is used for individuals with a functional gastrointestinal tract, but with disorders of the pharynx, esophagus, or stomach that prevent the intake of adequate nutrients. EN involves administering non-sterile liquids directly into the gastrointestinal tract through a nasogastric, gastrostomy or jejunostomy tubes.  An infusion pump may be used to assist the flow of liquids. Feedings may be intermittent or continuous (infused 24 hours a day).

POLICY

MEDICAL APPROPRIATENESS

IMPORTANT REMINDERS

SOURCES 

American Academy of Pediatrics. (2016). Clinical practice guidelines from the cystic fibrosis foundation for preschoolers with cystic fibrosis. Retrieved July 11, 2017 from https://www.aap.org.

American Society for Parenteral and Enteral Nutrition (A.S.P.E.N). (2002). Guidelines for the use of parenteral and enteral nutrition in adult and pediatric patients. Retrieved July 12, 2017 from http://pen.sagepub.com. 

American Society for Parenteral and Enteral Nutrition (A.S.P.E.N). (2011). Nutrition screening, assessment, and intervention in adults. Retrieved April 22, 2011 from http://www.nutritioncare.org.

American Society for Parenteral and Enteral Nutrition (A.S.P.E.N). (2017). ASPEN-FELANPE clinical guidelines: nutrition support of adult patients with enterocutaneous fistula. Retrieved June 26, 2019 from http://www.nutritioncare.org.

American Society for Parenteral and Enteral Nutrition (ASPEN). (2009). ASPEN clinical guidelines: nutrition support therapy during adult anticancer treatment and in hematopoietic cell transplantation. Retrieved June 11, 2018 from https://www.nutritioncare.org/Guidelines_and_Clinical_Resources/Clinical_Guidelines/.

Berry, A.J. (2014). Pancreatic enzyme replacement therapy during pancreatic insufficiency. Nutrition in Clinical Practice, DOI: 10.1177/0884533614527773. (Level 5 evidence)

Centers for Medicare & Medicaid Services. CMS.gov. NCD for enteral and parenteral nutritional therapy (180.2). Retrieved March 28, 2017 from https://www.cms.gov.  

Cystic Fibrosis Foundation. (2016). Enteral tube feeding for individuals with cystic fibrosis. Retrieved July 3, 2018 from www.cff.org.

European Society for Clinical Nutrition and Metabolism (ESPEN). (2005). ESPEN guidelines on artificial enteral nutrition – percutaneous endoscopic gastrostomy (PEG). Retrieved June 11, 2018 from http://espen.info/documents/PEG.pdf.

Freedman, S., Orenstein, D., Black, P, Brown, P., McCoy, K., Stevens, J., et al. (2017). Increased fat absorption from enteral formula through an in-line digestive cartridge in patients with cystic fibrosis. JPGN, 65 (1), 97 -101. (Level 2 evidence)

Miller, C & Madhoun, L. (2016). Feeding and swallowing issues in infants with craniofacial anomalies. American Speech-Language-Hearing Association, 5 (1), 13-26. (Level 5 evidence)

National Institute of Health and Clinical Excellence. (2006). Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition. Retrieved June 26, 2019 from www.nice.org.uk.

Pironi, L., Arends, J., Bozzetti, F., Cuerda, C., Gillanders, L., Jeppesen, P., et al. (2016). ESPEN guidelines on chronic intestinal failure in adults. Clinical Nutrition, 35 (2), 247-307. Abstract retrieved March 28, 2017 from PubMed database.

Winifred S. Hayes, Inc. Search & Summary. (2018, October). Relizorb (Alcresta Therapeutics Inc.). Retrieved June 26, 2019 from www.Hayesinc.com/subscribers.

ORIGINAL EFFECTIVE DATE:  5/4/1982

MOST RECENT REVIEW DATE:  8/8/2019         

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Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

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